Provider Demographics
NPI:1376356824
Name:OGDEN, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:OGDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 N 73RD ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507-2719
Mailing Address - Country:US
Mailing Address - Phone:402-404-0976
Mailing Address - Fax:
Practice Address - Street 1:2840 N 73RD ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68507-2719
Practice Address - Country:US
Practice Address - Phone:402-404-0976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1285447896Medicaid